Shoulder 3 Flashcards by Jessica Burgess

Remind yourself of the anatomy of the clavicle

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What age groups are clavicular fractures common in?

HINT: bimodal

Adolescents & young adults
60yrs (onset of osteoporosis)

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What classification system is used to classify clavicular fractures?

Allman classification

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Describe the Allman Classification

Type 1

# middle third
75% (as middle third is weakest)
Generally stable
But significant deformity present

Type 2

# lateral third
20%
When displaced, they are unstable

Type 3

# medial third
5%
Associated multi-system polytrauma
May be associated with neurovascular compromise, pneumothorax or haemothorax

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Describe how the medial and lateral segment of clavicle will displace in a #clavicle

Medial: elevate due to SCM
Lateral: depressed due to weight of arm > strength/support from trapezius

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Describe some common mechanisms of injury for #clavicle

Direct trauma
Indirect trauma e.g. fall onto shoulder

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State symptoms of a #clavicle

Pain
- Sudden onset
- Localised
- Severe
- Worsened by active movement of arm

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What might you find on examination of someone with #clavicle

Tenderness over clavicular region
Deformity (medial elevation, lateral depression)
Open injuries
Threatend skin (tented, tethered, white & non-blanching skin. May convert to open injury)

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What must you assess for if someone presents with #clavicle?

Neurovascular compromise

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What investigations would you do if you suspect #clavicle?

X-ray of clavicle (AP and modified axial)
?CT: might be needed to asses medial clavicle injuires as these can be hard to assess on x-rays

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Discuss the management of #clavicle

Most managed conservatively even if there is significant deformity.

Sling (to support elbow& improve deformity. Kept on until regain pain-free movement)
Encourage early movement of shoulder

Surgery is required for open fractures. Surgery for other #clavicle is controversial. ORIF required if fracture failed to unite.

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State some potential complications of #clavicle

Non-union
Neuorovascular injury
Puncture injury to lung resulting in pneumothorax or haemothorax

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What is the healing tiem for clavicular fractures?

4-6 weeks

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Remind yourself of the anatomy of the humerus

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Who are humeral shaft fractures common in?

HINT: bimodal

Younger pts (high energy trauma)
Older pts (low impact, osteopenia/osteoporosis)

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State some risk factors for humeral shaft fractures

Age
Osteoporosis
Previous fractures

State typical mechanism of injury in humeral shaft fracture

Fall on outstretched limb
Fall laterally onto adducted limb

What are symptoms of humeral shaft fracture?

Pain
Deformity
If radial nerve involved:
- Reduced sensation dorsum 1st webspace
- Weakend wrist extension

What might you find on clinical examination of a pt with humeral shaft fracture?

Deformity
Weakness wrist extension
Reduced sensation over dorsal 1st webspace
Open wounds

What must you assess when examing a pt with #humeral shaft?

Neurovascular status

Where do majority of humeral shaft fractures occur?

Medial third

What nerve is at risk in #humeral shaft and why?

Radial nerve as it passes through radial groove then runs along lateral edge of humeral shaft

The radial nerve is most likely to be damaged in what type of humeral shaft fracture?

Holstein-Lewis fracture
Fracture to distal 1/3 of radius
Results in entrapment of radial nerve

*Requires surgical management

What investigations are required for humeral shaft fractures?

X-ray: AP & lateral

Discuss the management of humeral shaft fractures

Mainstay of management= realignment of limb. _Conservative_ * Humeral brace *(used in most fractures of diaphysis)* * High elbow case *(if very distal fracture of humerus)* * Regular follow up & repeated x-rays _Surgical_ * Surgical fixation only needed in minority. Open reduction & internal fixation

How long does it typically take for the full union a humeral shaft fracture?

8-12 weeks

State some potential complications of humeral shaft fractures

* Non-union & mal-union (rare) * Varus angulation *(rarely causes functional limitation as shoulder can compensate)* * Radial nerve injury *(90% improve in 3/12 without intervention)*

Where is the most common site for a shoulder fracture?

Proximal humerus

Who do shoulder fractures commonly occur in?

Most commonly occur in elderly pts with osteoporosis who have fallen on outstretched hand

State some risk factors for a shoulder fracture

Risk factors are the risk factors for osteoporosis: * Female * Age * Early menopause * Prolonged steroid use * Recurrent falls * Frailty

State the symptoms of a shoulder fracture

* Pain aroudn upper arm & shoulder * Restricted movement * Inability to abduct arm

What might you find on clinical examination of someone with a shoulder fracture?

* Swelling * Bruising * Restricted movement * Damage to axillary nerve: * Loss of sensation in regimental badge area * Loss of power of deltoid muscle

What should you always assess in a supsected shoulder fracture?

Neurovascular status

What investigations would you do in a suspected shoulder fracture?

* **X-rays** (AP, lateral scapular, axillary) Others you may do: * Trauma: *urgent bloods- coagulation screen, group & save* * Pathological cause suspected e.g. cancer- *serum calcium, myeloma screen*

What classification system can be used to classify proximal humeral fractures? *\*Don't worry about details of it, just know neer classificaiton used to classify*

**Neer Classification:** classifies fractures based on relationship between 4 main segments of proximal humerus. Classified as displaced if \>1cm between segments or at least 45 degrees angulation. Classifies into minimal displacemtn or two to four part injuries. * Greater tuberosity * Lesser tuberosity * Articular segment (anatomical neck) * Humeral shaft (surgical neck)

Discuss the management of proximal humeral fractures

Majority managed conservatively: * Immobilisation initially followed by early mobilisation at 2-4 weeks * Polysling * Physiotherapy Srugery indicated if fracture is open, displaced or neurovascular compromise. Surgery may include ORIF, intermedullary nailing, hemiarthroplasty, reverse shoulder atrhoplasty.

State some potential complications of a proximal humerus fracture

* Reduced range of omotion * Avascular necrosis of humeral head

Scapular fractures are very rare; true or false?

* True * Scapula protected by surrounding muscles * Associated almost exclusively with high impact trauma * Majority treated non-operatively * Good results & no functional deficits in most cases